Delayed Diagnosis of Pancreatic Cancer Linked to Inadequate Imaging Studies

Case Overview

The margins of the removed lesion were found to be negative for cancerous cells, and doctors believed that the cancer was not invasive to the patient’s pancreas. This result prompted doctors to order a 6-month period of observation of the patient’s condition, primarily through the use of upper gastrointestinal endoscopy as well as ultrasound. Though the course of this observation period, the patient underwent multiple endoscopies, all of which were negative for suspicious lesions, however the doctor did not order any ultrasounds during the observation period. One year after the conclusion of the observation period for the initial lesion, the patient was diagnosed with a mass in the head of his pancreas, which necessitated a Whipple procedure and left the patient with a grim prognosis.

Questions to the Hematology expert and their responses

Can you determine whether surveillance of the pancreas by the means described above is the standard of care?

Surveillance of the pancreas by upper endoscopic ultrasound for total ampullectomy for this type of cancer, which is resected with negative margins indicated is within reasonable practice, which includes blood studies, chest radiograph, and a CT scan of the abdomen and/or pelvis every 6 months. Most of the literature suggests CT scan, not ultrasound, for additional monitoring. The National Comprehensive Cancer Network recommends it on PANC-6 category 2B recommendation, which means there is some disagreement among experts on this topic.

About the expert

This highly qualified, board certified, extremely well published expert earned his bachelor's degree from Yeshiva University and his medical degree from the State University of New York Downstate Medical College. This was followed by a residency in internal medicine at the New York Presbyterian Lower Manhattan Hospital and at Hahnemann University Medical Center. This expert then completed his formal medical education by pursuing a fellowship in Hematology and Oncology at the Long Island Jewish Hillside Hospital Medical Center. This expert has earned numerous awards for his contributions as a physician. This expert is extremely well published, having authored 28 Peer-reviewed Journal Articles, 10 Abstracts and 16 reviews. This expert's mastery of research has allowed him to serve as reviewer and editor for numerous leading medical journals. This expert previously held numerous positions, serving as Director of the Cancer Center of Generations Manhattan, Chief of Hematology and Oncology and associate director of the cancer center at Lincoln Medical Center, Co-Director of the Division of Medical Oncology and Hematology at Brookdale University Hospital, Associate Professor of Clinical Medicine at Cornell University and as Associate Professor of Medicine at the University of Medicine and Dentistry of New Jersey. This expert currently serves as Associate Attending at a regional hospital and on the Medical advisory board for a pharmaceutical company.

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Specialties:

Hematology

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.